Wherever possible, employers/payers and their pharmacy benefits managers (PBMs) should advocate for the following when it comes to compounds:
- Limit the approved use of compounds to only those injured workers with a documented need. This could be a medical condition that necessitates the use of a compounded medication or if the injured worker has not responded to prior attempts to use alternative commercially available medications.
- Request documentation from the prescriber. The prescriber should be able to provide evidence of the appropriateness of the compound, the clinical benefit expected from the compound and a treatment plan indicating the expected duration of need for the compound.
- Have an open dialogue with the injured worker. This should lead toan acknowledgement by the injured worker that he or she has been fully informed of the potential medical ramifications of using the prescribed compound by their physician.
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